1700070968 NPI number — DR. NATALIE MARIE WAGSTAFFE DDS

Table of content: DR. NATALIE MARIE WAGSTAFFE DDS (NPI 1700070968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700070968 NPI number — DR. NATALIE MARIE WAGSTAFFE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAGSTAFFE
Provider First Name:
NATALIE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WAGSTAFFE-STOUTE
Provider Other First Name:
NATALIE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1700070968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2411 CROFTON LN
Provider Second Line Business Mailing Address:
20A
Provider Business Mailing Address City Name:
CROFTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21114-1336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-721-0900
Provider Business Mailing Address Fax Number:
410-721-0915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2411 CROFTON LN
Provider Second Line Business Practice Location Address:
20A
Provider Business Practice Location Address City Name:
CROFTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21114-1336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-721-0900
Provider Business Practice Location Address Fax Number:
410-721-0915
Provider Enumeration Date:
08/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  13991 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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